Individual provider Active NPI

Jonathan S Dickinson, CRNA

  • Certified Registered Nurse Anesthetist
  • Bowling Green, KY
National Provider Identifier
1821082579
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3762A Issued in KY
Practice address
250 Park St
Bowling Green, KY 42101-1760
Phone
(270) 745-1000
Fax
(270) 393-1913
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3762A KY Primary

Addresses

Primary practice location

250 Park St
Bowling Green, KY 42101-1760

Mailing address

350 Park St
Ste 203 B
Bowling Green, KY 42101-1784
Phone (270) 393-1912

Other identifiers 2

IdentifierTypeStateIssuer
74005067MedicaidKY
000000238328OtherKYBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN, TN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040823001191 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 9234103557 Reassigns benefits to 5 organizations
I20160304000047 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9234103557 Reassigns benefits to 2 organizations
I20170510001293 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9234103557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Apr 19, 2021 Accepting new patients
Universal Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2020 Accepting new patients
Northstar Anesthesia of Kentucky, PLLC Nurse Anesthetist, Certified Registered CurrentSince May 6, 2016 Accepting new patients
South Central Ohio Anesthesia LLC CurrentSince Apr 1, 2016 Accepting new patients
Apollo Medical Group LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 8, 2016 Accepting new patients
Professional Anesthesia Services of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2018 Accepting new patients
Sweet Dreams Anesthesia Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Kentucky Anesthesia Group, PSC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2018 Accepting new patients
Tas of Kentucky LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations (25 of 29)

3423 Solutions Ctr
Chicago, IL 60677

1276 N Plaza Dr
Rockport, IN 47635
Phone (812) 649-2500

1451 N Gardner St
Scottsburg, IN 47170
Phone (812) 752-8500

8885 State Road 237
Tell City, IN 47586
Phone (812) 547-0185

4305 New Shepherdsville Rd
Bardstown, KY 40004
Phone (502) 350-5000

305 Estill St
Berea, KY 40403
Phone (859) 986-1415

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

55 Foundation Dr
Flemingsburg, KY 41041
Phone (606) 849-2351

1140 Lexington Rd
Georgetown, KY 40324
Phone (502) 868-1100

320 N Loretto Rd
Lebanon, KY 40033
Phone (270) 692-3161

2115 Harrodsburg Rd
Lexington, KY 40504
Phone (859) 276-2520

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

3480 Yorkshire Medical Park
#100
Lexington, KY 40509
Phone (859) 514-0260

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

3475 Blazer Pkwy
Lexington, KY 40509
Phone (859) 514-0260

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

2511 Terra Crossing Blvd
Louisville, KY 40245
Phone (502) 589-9488

4960 Norton Healthcare Blvd
Louisville, KY 40241
Phone (502) 446-8000

4130 Dutchmans Ln
Ste 300
Louisville, KY 40207

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

1099 Medical Center Cir
Mayfield, KY 42066
Phone (270) 251-4100

989 Medical Park Dr
Maysville, KY 41056
Phone (606) 759-3112

225 Falcon Dr
Mt Sterling, KY 40353
Phone (859) 497-5000

1000 Breckenridge St
Ste 100
Owensboro, KY 42303
Phone (270) 683-2751

1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1821082579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PARK ST",
            "address_2": "STE 203 B",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011784",
            "telephone_number": "270-393-1912",
            "fax_number": "270-393-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011760",
            "telephone_number": "270-745-1000",
            "fax_number": "270-393-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKINSON",
        "first_name": "JONATHAN",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3762A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74005067",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000238328",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.